Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 77777 DEA: CHEM-STOCK EFIS: CHEM-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for Chem Lab stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-03-19-2
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Acceptance
Type of Material: SMTL TM7 - Epoxy Coated Rebar
Sample Taken Date: 03/19/2026
Date that the sample was received by the laboratory/organization performing the testing: 03/26/2026
The quantity of what the sample constitutes: 60
A brief description of the sample: #5 ASTM A775 Epoxy Coated Rebaer
From where was the sample collected: Manufacturer
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Western Coating
Rebar Heat Number(s): 4148600
Rebar Epoxy Batch Number(s): BJ78927NA
Rebar Coating Specification: ASTM A775
Rebar Size (#): 5
Rebar Coating Color: Green
Rebar Manufacturer: CMC
Rebar Coater: Western Coating Ogden UT
Rebar Powder Manufacturer:
Release Number:
Quality Assurance Code:
